AP Exam 4 part VI

Question 1

which hypersensitivity reaction works by antigen-Ab complexes activating complement and destroying target cell

Answer 1

type II (cytotoxic)

Question 2

transfusion reaction, erythoblastosis fetalis, acute transplant rejection, and MG are what types of hypersensitivity reactiosn

Answer 2

type II (cytotoxic)

Question 3

SLE and RA are examples of what type of hypersensitivity reaction

Answer 3

type III (immune complex)

Question 4

mediators for type III hypersensitivity reaction

Answer 4

IgG, IgM, neutrophils, complement

Question 5

________________ reaction, is when an antigen-antibody complex forms and is deposited in tissues stimulating inflammation

Answer 5

type III (immune compelx)

Question 6

poison ivy and transplant rejections are what type of hypersensitivity reaction

Answer 6

IV (delayed)

Question 7

mediators for type IV hypersensitivity reaction

Answer 7

T cells, monocytes, macrophages, and cytokines

Question 8

graves dz is what type of hypersensitivity reaction

Answer 8

V (stimulatory)

Question 9

tx of anaphylaxis intraoperatively

Answer 9

1. discontinue triggering agent 2. trendelenburg 3. FiO2 = 100% 4. epinephrine 5. fluids (NS/LR 10-30 mL/kg) 6. secondary tx

Question 10

grade II anaphylactic reaction would require what dose of epi and what route?

Answer 10

10-20 mcg; SC/IM/IV

Question 11

grade III anaphylactic reaction would require wht dose of epi and what route

Answer 11

100-200 mcg SC/IM/IV q 1-2 min; 1-4 mcg/min

Question 12

grade IV anaphylactic reaction would require what dose or epi

Answer 12

1 mg IV repeat as needed: 0.05 - 1 mcg/min

Question 13

secondary tx for intraop anaphylaxis with epinephrine unresponsiveness

Answer 13

1. vasopressin 2-10 units IV 2. norepi: 0.05 - 0.1 mg/kg/min

Question 14

pt has anaphylaxis intraoperatively, what is your secondary tx if they are having bronchospasm 2/2 that

Answer 14

1. albuterol or ipratropium inhalants 2. terbutaline 0.25 mg SC (repeat in 15-30 min)

Question 15

if pt is having intraoperative anaphylaxis 2/2 preoperative Beta blockade, what is your 2ndary tx?

Answer 15

glucagon 1-5 mg IV q5min

Question 16

if pt is having anaphylaxis intraoperatively a secondary tx to consider is antihistamines, which ones?

Answer 16

1. diphenhydramine or hydroxyzine 0.5-1.0 mg/kg IV 2 & ranitidine 50 mg IV

Question 17

pt has intraoperative anaphylaxis, and has airway edema, what is the 2ndary tx?

Answer 17

hydrocortisone 100-250 mg IV

Question 18

surgery and anesthesia are associated with a generalized state of _______________________

Answer 18

immunosuppression

Question 19

factors contributing to the perioperative immune system dysfunction

Answer 19

1. surgery 2. blood transfusion 3. hyperglycemia 4. hypothermia 5. general anesthetics 6. opioids

Question 20

definition of a surgical site infection

Answer 20

one that occurs at or near the surgical incision within 30 days of the procedure, or within 1 year after implantation of prosthetic device

Question 21

surgical site infections accout for ________% of all hospital acquired or nosocomial infections in hospitalized pts

Answer 21

31

Question 22

the ____________ immune system is activated during surgery –> systemic _____________ within hours of procedure

Answer 22

innate; inflammation

Question 23

what is the neuroendocrine response to surgery?

Answer 23

elevated: epi, NE and cortisol

Question 24

how can we (as anesthesia providers) help in preventing surgical site infections?

Answer 24

Abx within 1 hour of cut time and sterile technique

Question 25

surgical excision of tumor may stimulate what?

Answer 25

proliferation and metastasis of tumor cells

Question 26

reasons that surgical excision of tumors can lead to proliferation and metastasis of tumor cells

Answer 26

1. excision disrupts vessels supplying tumor --> allowsing them into systemic circ 2. catecholamines (released with surgery) promote angiogenesis 3. angiogenesis increased postop --> tissue repair at surgical site, but contributes to tumor growth and metastasis

Question 27

how do blood transfusions effect on immune system

Answer 27

1. they depress the immune system 2. increase incidence of SSI 3. promote earlier recurrence of cancer

Question 28

what type of blood products are recommended for cancer patients ?

Answer 28

irradiated or leukocyte depleted blood products to offset the depression of the immune system by donor leukocytes

Question 29

use of intraoperative cells savers (i.e. recycling blood) contributes to ___________________ in cancer pts

Answer 29

recurrence of cancer

Question 30

hyperglycemia effect on the immune system

Answer 30

1. depression of innate and adaptive immune systems 2. increases SSI and poor patient outcomes

Question 31

T/F: even transient episodes of hyperglycemia can depress immune fx

Answer 31

TRUE

Question 32

a blood glucose level between ________________ can decrease the effects of hyperglycemia on the immune system

Answer 32

140-180

Question 33

effects of hypothermia perioperatively on the immune system

Answer 33

1. increases blood loss 2. impairs wound healing 3. decreases immune function 4. increases need for blood transfusion --> even further decrease in immune system

Question 34

_________________ anesthesia attenuates surgical stress response and preserves normal immune fx

Answer 34

regional

Question 35

opioids suppress fx of _______________ cell activity

Answer 35

natural killer

Question 36

volatile anesthetics on cancer recurrence

Answer 36

conflicting evidence; insufficient evidence to avoid in cancer surgery

Question 37

N2O effect on cancer reccurence?

Answer 37

no effect

Question 38

L.A. effect on cancer recurrence

Answer 38

decreased cancer recurrence and metastasis

Question 39

neuraxial anesthesia effect on cancer recurrence

Answer 39

reduce recurrence and metastasis

Question 40

NSAIDs affect on cancer recurrence

Answer 40

acute or chronic use associated with tumor regression (beneficial choice)

Question 41

ASA affect on cancer

Answer 41

reduces cancer metastasis

Question 42

opoids effect on cancer recurrence

Answer 42

promotes cancer progression and decreased long term survivial

Question 43

supplemental O2 > ___________% postoperatively have shorter cancer free survival period

Answer 43

80

Question 44

dexmethasone effect on cancer recurrence

Answer 44

no effect on cancer recurrence or survival

Question 45

anesthetic technique on immunocompromised pt

Answer 45

1. strict aseptic technique and maximum barrier precautions 2. GA or RA or combined 3. prophylactic Abx administered 30 min prior to incision 4. active warming measures to avoid hypothermia 5. perioperative management of blood glucose to avoid hyperglycemia 6. leukocyte poor/irradiated blood products should be used when transfusion unavoidable 7. multimodal approach for postop pain control (regional + nonopioids)

Question 46

T/F: the overall risk related to anesthesia has declined

Answer 46

TRUE

Question 47

death attributable to anesthesia is ______________

Answer 47

rare

Question 48

there is lack of consensus on time frame for "anesthesia-related mortality," but could be btwn _____-_____ post-anesthesia

Answer 48

24h; 30 days

Question 49

________________ hypersensitivity reaction is mediated by IgE, mast cells, and basophils

Answer 49

type I

Question 50

_______________ hypersensitivity reaction is mediated by IgG, IgM, compliment

Answer 50

type II (cytotoxic)